Objective To compare the application value of contrast enhanced ultrasound (CEUS) and contrast enhanced magnetic resonance angiography ( CEMRA ) in the diagnosis of carotid plaque characteristics . Methods Fourty-six patients ( 48 carotid plaques) were performed with carotid CEUS and CEMRA examination prior to carotid endarterectomy . The following characteristics of plaque including the surface of the plaque ,the presence of calcification ,the internal composition and the diameter stenosis were observed and measured ,which were compared with pathologic and digital subtraction angiography ( DSA ) results . Results There were 42 vulnerable plaques and 6 stable plaques in the 48 plaques . Fourty-seven carotid plaques had been correctly diagnosed by CEUS and CEMRA ,and one plaque had been misdiagnosed . The sensitivity ,specificity and accuracy between CEUS and CEMRA had no obvious differences in terms of the overall evaluation of plaque vulnerability ( P > 0 .05) ;CEUS and CEMRA in the diagnosion of the plaque surface situation had no statistical difference in terms of sensitivity ,specificity and accuracy compared with pathological results( P > 0 .05) ;There was no significant difference in diagnostic accuracy rate between two modalities ( P < 0 .05) ;In the diagnosis of plaque internal composition ,they had statistically differences in terms of specificity and accuracy ( P < 0 .05) ,while sensitivity had no obvious difference ( P > 0 .05) . With DSA examination results as the gold standard ,the accuracy of CEUS in the diagnosis of the diameter stenosis was 97 .92% (47/48) ,CEMRA was 100% (48/48) ,they had no significant difference between two groups ( P > 0 .05 ) . Conclusions CEUS and CEMRA in carotid plaques characteristic evaluation have respective advantages ,are highly complementary ,and combining two methods can systematically evaluate for plaque characteristics .

OBJECTIVETo observe clinical therapeutic effects of acupuncture combined with medication in restoration of gastrointestinal functions for postoperative patients with gastric cancer.

METHODSNinety patients undergoing radical surgeries for gastric cancer were randomly, according to the sequence of their operations, divided into three groups: a control group treated conventionally after their surgeries (group CONT, 30 cases), a Chinese medicine group treated by Simo Decoction administered by way of a nutrient canal in addition to the conventional treatment (group CM, 30 cases), and an acupuncture plus Chinese medicine group treated by warming needling in addition to those given in the Chinese medicine group (group ACUP+CM, 30 cases). Therapeutic effects were estimated 10 days after their operations.

RESULTSThe time for restoration of gastrointestinal functions was obviously shortened, and the problems of poor appetite and difficulty in defecation were more markedly improved in group ACUP+CM than those in both group CONT and group CM (P < 0.01, P < 0.05). Ten days after operations, the number of patients with normal lymphocytes and normal percentage rate of lymphocytes to neutrophile granulocytes was obviously more in group ACUP+CM than those in both group CONT and group CM (P < 0.01, P < 0.05).

CONCLUSIONAcupuncture combined with Chinese medicine is favorable in accelerating early air exhaustion and defecation, improving clinical symptoms, as well as in bi-directional regulating peripheral white blood cells.

Acupuncture Therapy ; methods ; Aged ; Combined Modality Therapy ; Drugs, Chinese Herbal ; administration & dosage ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Postoperative Care ; methods ; Recovery of Function ; Stomach Neoplasms ; physiopathology ; surgery ; therapy ; Time Factors ; Treatment Outcome

OBJECTIVETo evaluate the safety and efficacy of thoraco-laparoscopic subtotal esophagectomy in the treatment of esophageal cancer.

METHODSClinical data of 98 patients with esophageal cancer who underwent thoraco-laparoscopic subtotal esophagectomy from March 2009 to October 2011 were retrospectively analyzed. One hundred and five patients were served as controls who underwent open three-field subtotal esophagectomy in the same period.

RESULTSThere were significant differences between thoraco-laparoscopic and open three-field subtotal esophagectomy in blood loss [(85.1±32.8) ml vs. (215.5±60.6) ml], length of stay [(12.7±3.5) d vs. (16.9±4.5) d]), pneumonia (4.1% vs. 12.4%, P<0.05), atelectasis (3.1% vs. 10.5%, P<0.05), pleural effusion (3.1% vs. 10.5%, P<0.05), acute respiratory distress (1.0% vs. 7.6%, P<0.05) and arrhythmia (4.1% vs. 12.4%, P<0.05). No significant differences were observed in the number of lymph node harvested, operative time, anastomotic leak, thoracic abscess, chyle chest, re-laparotomy, re-thoracotomy, vocal cord paralysis, renal failure, gastric emptying, and mortality (all P>0.05).

CONCLUSIONThoraco-laparoscopic subtotal esophagectomy is technically feasible and safe and is associated with less blood loss, less cardiopulmonary complication, and shorter hospital stay.

Aged ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Female ; Humans ; Laparoscopy ; Lymph Node Excision ; Male ; Middle Aged ; Retrospective Studies ; Thoracoscopy ; Treatment Outcome

OBJECTIVETo evaluate the clinical value of activated carbon nanoparticles for guiding lymphadenectomy in lung cancer.

METHODSFourty-two lung cancer patients were divided into two groups: the control group (22 cases) and experiment group (20 cases) who received activated carbon nanoparticles injection around the tumor either by endoscopic injection or intraoperative subserosal injection. The number of dissected lymph node, black-stained lymph node, positive lymph node and the side effect of the procedure were analyzed, respectively.

RESULTSNo severe complication was observed in the experiment group. The operative time was not prolonged significantly in the experiment group either. However, the number of average lymph nodes dissected in the experiment group (25.5) was significantly more than that in the control group (14.6) (P <0.01).

CONCLUSIONLocal injection of activated carbon nanoparticles around the tumor during surgical exploration is effective, safe and easy to do for guiding lymphadenectomy in lung cancer patient.

Adult ; Aged ; Charcoal ; Female ; Humans ; Lung Neoplasms ; pathology ; surgery ; Lymph Node Excision ; methods ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Nanoparticles ; Pneumonectomy

BACKGROUND AND OBJECTIVESince the proposal of the tumor stem cell hypothesis, considerable interest has been devoted to the isolation and purification of tumor stem cells. Tumor stem cell enrichment from primary tumor derived cell spheres has been demonstrated in specific, serum-free media. This goal of this study is to establish a method of cultivating floating tumor spheres from neuroblastoma cells and to confirm that neuroblastoma spheres are rich in tumor stem cells.

METHODSBone marrow aspirates were obtained from pediatric patients diagnosed with stage IV neuroblastoma. Primary tumor cells were isolated and cultivated in serum-free, stem cell-selective medium. Single sphere-forming cells were cultivated under serum-free conditions; their cloning efficiency and monoclonal tumor sphere formation rates were calculated. The expression of stem cell marker genes Oct-4 and Bmi-1 was detected by RT-PCR in sphere-forming cells and parental neurolastoma cells. Sphere-forming cells were injected into the armpit of nude mice with subsequent assessment for tumor growth. Sphere-forming cells were cultivated in differentiation medium containing 5 μmol/L 13-cis retinoic acid; changes in cell morphology were observed.

RESULTSNeuroblastoma cells formed non-adherent neurospheres under serum-free, stem cell-selective conditions after a period of 4 to 6 days. A single cell dissociated from a neurosphere could reform a monoclonal sphere; cloning efficiency and monoclonal sphere formation rates were 55.3% and 26.3%, respectively. RT-PCR results revealed heightened tumor sphere expression of Oct-4 and Bmi-1 as compared with parental tumor cells. Fourteen days after injection of 10(4) sphere-forming cells into nude mice, a neuroblastoma xenograft formed. Treatment of sphere-forming cells with 13-cis retinoic acid induced a gradual differentiation to neuronal cell morphology.

CONCLUSIONSNeuroblastoma derived tumor spheres enrich tumor stem cells and the cultivation of primary neuroblastoma cells in serum-free, stem cell-selective medium is an effective method to dissociate and purify tumor stem cells in vitro.

Animals ; Cell Culture Techniques ; methods ; Cell Differentiation ; drug effects ; Child ; Culture Media, Serum-Free ; Humans ; Isotretinoin ; pharmacology ; Mice ; Mice, Nude ; Neoplasm Transplantation ; Neoplastic Stem Cells ; metabolism ; pathology ; Neuroblastoma ; metabolism ; pathology ; Nuclear Proteins ; metabolism ; Octamer Transcription Factor-3 ; metabolism ; Polycomb Repressive Complex 1 ; Proto-Oncogene Proteins ; metabolism ; Repressor Proteins ; metabolism ; Spheroids, Cellular ; pathology ; Xenograft Model Antitumor Assays

OBJECTIVETo evaluate the clinical value of endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) biopsy for diagnosis of PET-CT positive mediastinal lymph nodes.

METHODSOne hundred and twenty-six patients with lung cancer undergoing both PET-CT scanning and EBUS-TBNA biopsy in the First Affiliated Hospital of Guanzhou Medical College from July 2008 to August 2010 were included in this study. There were 89 male and 37 female patients with a mean age of 56.3 years (range 34 to 81 years). (18)FDG-PET was considered positive in mediastinal nodes if the PET-CT reported hypermetabolic activity consistent with malignant disease (standardized uptake value > 2.5). All of the patients were clinically followed up.

RESULTSAmong the 126 patients, 185 stations of lymph nodes were punctured. The mean diameter of the nodes was 13.6 mm and the range was 6 - 23 mm. There were no procedural complications. The diagnostic accuracy, sensitivity, and specificity of EBUS-TBNA were 95.7%, 95.7%, and 100%, respectively.

CONCLUSIONSEBUS-TBNA is a minimally invasive, highly effective and accurate, practical and safe procedure for diagnosis of PET-CT positive mediastinal lymph nodes.

Adult ; Aged ; Aged, 80 and over ; Biopsy, Needle ; methods ; Bronchoscopy ; Endosonography ; Female ; Humans ; Lung Neoplasms ; diagnosis ; pathology ; Lymph Nodes ; diagnostic imaging ; pathology ; Lymphatic Metastasis ; diagnosis ; pathology ; Male ; Mediastinum ; diagnostic imaging ; pathology ; Middle Aged ; Positron-Emission Tomography ; Sensitivity and Specificity ; Tomography, X-Ray Computed

Objective To explore the value of intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI ) in patients with progressive muscular dystrophy .Methods We enrolled 7 patients with known progressive muscular dystrophy (4 Becker muscle dystrophy ,BMD;3 limb-girdle muscle dystrophy ,LGMD) in this study .Both IVIM ,T1 WI and T2 STIR sequences were performed on both thighs of all the subjects .Slow ADC ,fast ADC and fraction of fast ADC (Ff ) were measured .Tl weighted images were used to assess the fat infiltration of their thigh muscles using a 0-5 modified version of Mercuri's scale .Slow ADC ,fast ADC and fraction of fast ADC (Ff) were compared among the fatty infiltration ,edematous muscle and unaffected muscle (neither edematous nor fatty infiltration muscles in patients ) .One-way analysis of variance was used for statistical analyses with a significance of P < 0 .05 . Results The mean slow ADC value of fatty infiltration . edematous muscle . and unaffected muscle was 0 .75+0.39,1 .14±0 .19,and 1.00±0 .11 (10 -3 mm2/s ) , respectively ( P < 0 .05 ) .The mean fast ADC value in the three groups was 7 .14±6 .51,13 .56±9 .67,and 4 .02±1.89 (10-3 mm2 /s ) , respectively (P< 0 .05 ) . There was no significant difference in the Ff values among the three groups ( P > 0 .05 ) .The mean slow ADC value in different grades of steatosis was 1 .00±0 .11, 0.98±0 .17, and 0 .50±0 .29 (10-3 mm2/s) , respectively ; the slow ADC value in heavy fat infiltration group differed significantly from that in the other two groups( P<0.05 ).Conclusion IVIM-DWI can be used to quantitatively evaluate the thigh diffusion and microcirculation characteristics of muscles in patients with PMD , make a quantitative analysis of edema and steatosis of the muscle .and reflect the degree of muscle steatosis .

Objective To evaluate the safety and feasibility of the retrosigmoid suprameatal approach (RSSMA) for petrous apex resection. Methods Ten human dry skull and 18 cadaverie skull specimens were collected and 3-dimensional CT scanning was performed with slice thickness of 1 mm. Craniotomy was performed on the specimens through a modified retrosigmoid approach, and the suprameatal tubercle (ST) and petrous apex (PA) were removed without damaging the trigerninal and facial nerves. The petrous bone was resected to the farthest lateral margin (FLM) that the approach could allow. CT-based and manual measurements were used to determine the lateral-middle line, superior-inferior, anterior-posterior lengths of the ST and PA. The superolateral lip of the internal auditory meatus (SLIAM) was defined as the landmarks for the measurement, and the distances from the SLIAM to the fundus, the common crus, and vestibule was determined. Results From thesuperior-inferior to the anterior-posterior and median-lateral directions, the resection rate of the PA increased to (26.6±6)%, (45±5)%, and (72±6)%, and the rate for the ST to (69±10)%, 100%, and 100%, respectively. The resection rate of the PA at the siphonal portion was (44±7)%. In the RSSMA, the distance from the SLIAM to the FLM (17.6±2.0 mm) was greater than the distances from the SLIAM to the vestibule (10.1±1.4 mm), the fundus (10.4±1.5 mm), and the common crus (10.6±1.1 mm). Conclusions The RSSMA may well protect the siphonal portion of the internal carotid artery from damages in PA resection. The FLM of the RSSMA is always lateral to the vestibule and the fundus of the internal auditory canal and the common crus, and therefore injuries to the vestibule, the semicircular canal and the common crus should be avoided.

OBJECTIVETo study the rate of human immunodeficiency virus (HIV) seroconversion, HIV transmission and related risk factors among injecting drug users (IDUs) in an area of Sichuan province.

METHODSIn November 2002, a community-based baseline survey was conducted to recruit 333 HIV-seronegative IDUs for a prospective cohort study in Xichang county of Sichuan province, China. Follow-up visits were carried out every 6 months to study the situation of drug use, sexual behaviors of the IDUs and blood specimens were collected to test for antibodies against HIV and syphilis.

RESULTSDuring a 24-month follow-up period, cohort retention rate and HIV incidence were 75.7% and 2.53 per 100 person-years [95% confidence interval (CI): 1.10-3.97)], respectively. Multivariate Poisson regression model showed that risk factors which were significantly associated with HIV seroconversion would include: ethnicity (RR = 12.42; 95% CI: 2.72-56.74, P = 0.0012) and needle or syringe sharing in the past 3 months (RR = 4.06; 95% CI: 1.29-12.81, P = 0.0168). Syphilis seroconversion in this cohort was 4.71 per 100 person-years (95% CI: 2.59-6.82). In multivariate Poisson regression being female (RR = 4.42; 95% CI: 1.78-10.99, P = 0.0014) appeared to be the only factor which was significantly associated with syphilis seroconversion.

CONCLUSIONOur study results showed that there was a rapid transmission of HIV and syphilis among IDUs in Sichuan province, suggesting that effective intervention should be urgently taken.

Cohort Studies ; HIV Seropositivity ; immunology ; transmission ; Humans ; Prospective Studies ; Risk Factors ; Sexual Behavior ; Substance Abuse, Intravenous ; Syphilis ; immunology ; transmission

OBJECTIVETo explore factors associated with retention in a community-based methadone maintenance treatment (MMT) among heroin addicts in Xichang of Sichuan province.

METHODSAll 206 heroin addicts were first admitted to MMT community-based program between March to September 2004. Baseline data of patients characteristics, social function, drug using behaviors, sexual behaviors, dose of methadone and retention were collected.

RESULTSUp to Oct, 2005, all 206 patients contributed 8.98 +/- 5.74 person-months of following-up. The retention rates were 58.7% after 6 months and 34.6% after 12 months respectively. Cox proportional hazard regression model indicated that the employed (HR, 0.60; 95% CI, 0.39 - 0.92), helping family to do housework in past 30 days more than once a day (HR, 0.59; 95% CI, 0.42 - 0.82) and previous self-detoxification > or = 3 times (HR, 0.65; 95% CI, 0.47 - 0.91) were independently associated with retention.

CONCLUSIONWe should give individual counseling to help heroin addicts increasing compliance.

Adult ; Cohort Studies ; Community Health Services ; methods ; Female ; Heroin Dependence ; epidemiology ; rehabilitation ; Humans ; Male ; Methadone ; therapeutic use ; Middle Aged ; Prospective Studies ; Regression Analysis ; Treatment Outcome